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Kaletra is actually two drugs combined into a single capsule: lopinavir and low doses of ritonavir (Norvir), another protease inhibitor manufactured by Abbott Laboratories. This is because ritonavir increases the amount of lopinavir in the blood, thus making it more effective against HIV.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

If you're a LTNP there is no reason to be taking any medication. Your body is controlling the infection itself. I was a LTNP for 21 years and never on any medication.

Those were my thoughts also. If you are undetectable, whats the need of medication. Monotherapy or anything else, unless I am missing something here. I was diagnosed positive in 1985. In 1999, I had a 900 t-cell count and a viral load in about the same range. By 2003, 16 t-cells and 500,000 viral load. go figure... Of course, I would have done things differently looking back, but can't do that either.

I think he's just wishing he's a LTNP. And who wouldn't? I thought a decade would have to pass in order to label oneself that.

It took only 6 months off meds before NIH threw genetic testing at me to label me an LTNP in light of my past. My doc at Dx ten years ago thought about it often, given my history; but with my viral load soaring near 700K and CD4s dipping near 200 while battling hep A, he felt that I needed to get on old-school HAART ASAP. Later, we did Ziagen monotherapy for over two years with viral suppression below 50 copies, in his mind to acclimate me to the notion of being a LTNP, but I kept clinging to meds for a couple more years.

As for wishing to be an LTNP, I don't believe that anyone who isn't one can completely grasp the additional layer of apartheid that we may feel. The experience with HIV is markedly atypical of the norm, so I'm cautious of being taking a public label as an HIVer, even if pics of my daddyliciousness and my biohazard tat have been all over the internet. Then, there's feeling an additional responsibility for the care of my physical form, not only as an embodiment for my spirit, but also as a source of academic curiosity. And, lastly, it's the inabilty to comiserate authentically about OIs and other crap that comes along with the disease which I'll likely never experience. I may have washed the KS-covered bodies of friends, read to and fed those with CMV retinitis or PML, and dished out tons of pointers on thrush care, but I am unlikely to personally experience any of it.

It took only 6 months off meds before NIH threw genetic testing at me to label me an LTNP in light of my past. My doc at Dx ten years ago thought about it often, given my history; but with my viral load soaring near 700K and CD4s dipping near 200 while battling hep A, he felt that I needed to get on old-school HAART ASAP. Later, we did Ziagen monotherapy for over two years with viral suppression below 50 copies, in his mind to acclimate me to the notion of being a LTNP, but I kept clinging to meds for a couple more years.

As for wishing to be an LTNP, I don't believe that anyone who isn't one can completely grasp the additional layer of apartheid that we may feel. The experience with HIV is markedly atypical of the norm, so I'm cautious of being taking a public label as an HIVer, even if pics of my daddyliciousness and my biohazard tat have been all over the internet. Then, there's feeling an additional responsibility for the care of my physical form, not only as an embodiment for my spirit, but also as a source of academic curiosity. And, lastly, it's the inabilty to comiserate authentically about OIs and other crap that comes along with the disease which I'll likely never experience. I may have washed the KS-covered bodies of friends, read to and fed those with CMV retinitis or PML, and dished out tons of pointers on thrush care, but I am unlikely to personally experience any of it.

Namaste,David

off topic...I've always wondered if LTNPs are protected from HIV-associated dementia

Kaletra is actually two drugs combined into a single capsule: lopinavir and low doses of ritonavir (Norvir), another protease inhibitor manufactured by Abbott Laboratories. This is because ritonavir increases the amount of lopinavir in the blood, thus making it more effective against HIV.

Ann -- I think most researchers consider it monotherapy, since the Norvir is only used as a booster, and not as an antiviral. That's why all the studies looking at Kaletra alone are called "Kaletra monotherapy studies." In turn, if Reyataz + Norvir were studied alone, it would still be called a Reyataz monotherapy study.

Ohhh -- I got to correct Ann!! Maybe she'll ban me!

Holding my breath,

Peter

P.S. The original question will probably never be answered. Since LTNPs can take 10-20 years to progress (or longer), no one will ever do a study to see if putting them on ANY early therapy extends that time range even further.

P.S. The original question will probably never be answered. Since LTNPs can take 10-20 years to progress (or longer), no one will ever do a study to see if putting them on ANY early therapy extends that time range even further.

How could you ever know anyway? Wouldn't that be trying to prove a negative, so to speak? How could anybody know when someone "would have progressed" in the first place?

Maybe we can better help John if he had a thread about this and related subjects such as bimazek does? It's getting hard to keep track of all of these similar posts of his throughout the forum and he definitely has questions that are important to him.

P.S. The original question will probably never be answered. Since LTNPs can take 10-20 years to progress (or longer), no one will ever do a study to see if putting them on ANY early therapy extends that time range even further.

I believe the situation is even more convoluted. With the medical rush to treat and the human instinct for self-preservation, newly infected potential LTNPs will overwhelmingly go unnoticed and "needlessly" take years of meds, though their systems could have fared well without them. Most docs and new HIVers don't grasp the CD8/CD4 equillibrium at play in many LTNPs, and they'll go for the pills after a couple successive labs with CD4 decline and detectable bugs, though the CD8s may be screaming "Look at us! We're kicking HIV ass!"

Still, the answer to ferreting out potential LTNPs shortly after infection would involve a new standard of care for the newly infected which our medical spending and our individual tolerances for uncertainty would not tolerate. Delta-32 screening and HLA-B haplotyping for the newly infected could point to potential LTNPs, but at a high cost for what the holders of purse strings would surely judge as a small yield. Educating doctors, clinic cousenlors, and the public about LTNP immune response patterns and the "need" to wait out HAART initiation would be an even more difficult morass. However, that's what we'd need to identify more LTNPs early, instead of stumbling upon us after years of blissful ignorance.

I sure do miss the resident scientists and doctors who use to post around here. They did such a wonderful job of explaining topics like this in laymen terms. No gobbledy goop, frills or opinions to confuse the issue,just scientifically based facts.

Maybe we can better help John if he had a thread about this and related subjects such as bimazek does? It's getting hard to keep track of all of these similar posts of his throughout the forum and he definitely has questions that are important to him.

It is an interesting theory as to when, or whether we LTNP's will progress as some have. The LTNP researchers that I work with say that while it is likely that I won't progress it is not by any means a guarantee. I hold my breath each time I participate in a study, waiting for the results. I count each healthy day as a blessing, not a sure thing,even after 27 years.

It says in the above link that (as Paul says), some Elite Controllers do experience CD4 depletion despite controlling viral replication. It is possible, as I understand it, to progress to AIDS even in the absence of a measurable viral load. This is news to me -- the link above is the first news I personally have seen of this as a possibility.

This being the case, there might indeed be benefit of some kind of drug therapy for elite controllers if their T-cells start to fall. I don't have any answers but it is an interesting question.

I think too often people take science as fact and forget that science is always evolving. What we learned about HIV/AIDS yesterday might get updated tomorrow. We should all keep that in mind.

I'm not sure if that risk calculator can really tell you anything ....

Well, it's certainly meaningless if one is in an actual effective LTNP category, as the weight given to ARVs becomes meaningless, as does the facotring of viral rebound that must occur in the background.

As I indicated earlier, the prospects of organizing a meds study on LTNPs don't appear good, given the current state in disease management and the prohibitive cost of testing for LTNP characteristics along with, for instance, running a Western Blot or the first set of viral load and CD4s.

I guess you find the question interesting because you maybe think:LTNP remains long term non progressors until they progress.. (or are we EC, LTNP, DP, ? etc..)So in most case, it's a matter of time that being on drugs will become the safest route.(And also you might want to take drugs to support your body sooner or later in his fight)

Now if the risk calculator give an estimation on how safe the drug route might be, it did not tell you when to start HAART (providing as such just a partial answer)

A: The difference is, at least, the delay between the infection and the HAART initiation But wherever we are on this timeline, the great majority of us if not all are shifting to the right.So a day or another, the risk calculator become more accurate (assuming it is mixing all progressors profiles,that is, mainly a population of 98% of DP, P or FP )

The unknown variables are:where are you on the timeline and how much immune recovery is enough (*) ?

John

(*) As the drugs are restoring partially our immune systems (less with time).In the balance as well the SMART study shows that initiating HAART earlier result in less side effects and better response.

do you think, based on your experience (symptoms, reading, etc.) that it could be of any benefice for a LTNP to start a monotherapy:In others words, can a monotherapy extends the life expectancy, reduce the OI risks and maybe postpone for decade the HAART (more toxic) that would have maybe to be taken (much) earlier without a monotherapy ?Maybe a monotherapy is even enough (the body is the other drug)

What about resistances ? Taking a monotherapy might maybe allow the body to focus (specialize) on resistant strain ?

No there is no benefit. Why would one be taking drugs when they don't need them? Hell a Dr. doesn't start people on Meds until they are below 350 so why on earth would you be given drugs. My CD4 stayed above 1400 for 21 years and I never got over a 4500 VL. Do you think a doctor would have started me on Meds when I had a normal CD4? No. There would be no benefit in starting meds, you would probably cause more problems to your organs. Would you take Antiarrhythmic medication when your heart isn't throwing arrhythmias? Of course not.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

- Maybe the immune system of a LTNP associated with a monotherapy might be equivalent to taking HAART.- Even if in the timeline, the treatment is start a bit earlier (as no clues exists on how long soemone will remain a EC/LTNP/DP), the SMART study have shows that a bit earlier (even before 350 CD4) might be better.

This thread just seems silly to me. I always thought one of the 'luxuries' of being an LTNP was not having to be on meds. Of course, this can all change, as even some LTNP's end up on meds. I do know that often HIV+ folks have to change meds due to resistance. Why the hell somebody would want to build up resistance by using a failure prone regimen (monotherapy) and suffer side effects unnecessarily is beyond me.

Have you ear at least about the Kaletra monotherapy study for non LTNP ?Have you ever think why pharma, doctor and researcher can even think in 2008 to a monotherapy for treatment naive patient without having think prior that to arguments like your ?

Haven't you understand that an ID Doc just use labs to diagnose you, and surveys to choose your drugs ?And that pharma use studies to evaluate drugs ?So what ? If a study is not done, all the chain collapse. If your ID doc is missing a lab or a survey, he just won't treat you in the best possible way.

In others words, if you do not raise questions, you just become dependent on the wills of others.And if you are not lucky choosing your doc, you won't go far.

As I am working in a developing country, and as at least the docs here do not have cutting edges skills, I have to raise what seems to me the rights questions.

From there, read the studies, side effects and so.

Doing so, here is an extract of the Kaletra monotherapy study:It has been suggested that using a Norvir (ritonavir)-boosted protease inhibitor (PI) without the use of other antiretrovirals to treat HIV is less effective, and more likely to cause drug resistance, than standard three-drug regimens in clinical trials. However, in an editorial published in the March 30 issue of AIDS, researchers argue that PI monotherapy has the potential to guard against side effects and preserve future treatment options, thereby keeping it in the limelight as a potential treatment option that deserves further research.

Now again, this study have been made on treatment naive and non LTNP patient. How about that ?Feeling upset ? So if such question have make sens to scientist, then the same question but for LTNP make sens as well.

Especially knowing that:- Your body is creating resistances with or without drugs. Even when you are undetectable. - Most if not all LTNP will became a day or another FP.- The conclusions of the study above were: i- 90 percent of people on monotherapy whose virus dropped to less than 400 copies by the fourth week of treatment in the Monark study went on to maintain undetectable viral loads for 48 weeks of treatment ii- A strategy of PI monotherapy for most patients, with intensification for the few who need it, may be attractive for many patients and clinicians iii- Several new monotherapy trials are moving forwardósome using Kaletra, and others using Reyataz (atazanavir) or Prezista (darunavir) boosted by Norvir. In most cases, people are being treated initially with three-drug regimens to reduce their viral loads to undetectable before switching to monotherapy. Hopefully, monotherapy will be associated with better long-term efficacy in these studies than in trials completed thus far.

Now the LTNP have an advantage among others:They body can control the virus, but their body is doing overtime to reach that.A day or another, the body surrender. What if you support your body before he surrender ?May the immune system + montotherapy become equivalent to HAART for FP ?

No clues on when the body will give up, but LTNP might want to consider at least taking a monotherapy when some signs become visible. Up to their will.But to do so, they may need to do same the doc, get a study available. That is the question raised in this thread.

In others words, if you do not raise questions, you just become dependent on the wills of others.And if you are not lucky choosing your doc, you won't go far.

As I am working in a developing country, and as at least the docs here do not have cutting edges skills, I have to raise what seems to me the rights questions.

John,If you are in a developing country, the population does not have a marked percentage of LTNPs present, so this line of questioning seems far from "the right questions." And, again, even if you had LTNPs present in the small numbers found among descedants of Northern Europeans, the cost of detecting LTNPs early would be impractical.

As for suggesting a boosted PI monotherapy, LTNPs with any sense of self-determination will tell you to shove it. Any added years on our run without AIDS would certainly be offset by increased cardiac risk factors from the PI.

I still don't understand how "detecting LTNP's early" is even possible - just by definition.

And if you do start therapy - even some sort of monotherapy - then you by definition cease to be a LTNP, right? Since you are now maintaining by way of some sort of chemical therapy.

And John, what is up with all this post - log off, post - log off business? It's quite obvious to everyone that you are still just hanging around lurking in wait for responses. That's the kind of crap net trolls do, ya know.

As I am working in a developing country, and as at least the docs here do not have cutting edges skills, I have to raise what seems to me the rights questions.

This is an interesting twist. Do you mean you receive your care in a developing country? I thought your testing and treatment was done in Belgium. Are you working with doctors and HIV positive people in a developing country ? Do the doctors lack skills or resources? Have you run your theory by you own doctors? Have you posed the question to the experts at the Body.com. At times you read like you're not even positive.

buy a Palm Pilot like cell phone, and you will log on log off maybe more than me.

John

Hey! You're pretty high tech in that developing country!

Quote

This is an interesting twist. Do you mean you receive your care in a developing country? I thought your testing and treatment was done in Belgium. Are you working with doctors and HIV positive people in a developing country ? Do the doctors lack skills or resources? Have you run your theory by you own doctors? Have you posed the question to the experts at the Body.com. At times you read like you're not even positive.

It does get confusing. It's a bit like an AIDS version of Where's Waldo?

redhotmuslbear,when the LTNP give up, he get HAART nowadays.How bad for the heart is that compared to a monotherapy ?

John,I'll let someone else take exception to the words "give up."

Still, you're making a lot of assumptions here. I would suggest that if an LTNP showed persistent failure to control HIV, treatment decisions taken with a doctor would be start with a minimal medication burden, not triple-drug therapy, as you suggest. Even if triple-drug therapy was started, there are combinations like NVP+FTC+TFV that do not jack up triglycerides or impose other cardiac risk.